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STATEMENT OF MORTGAGE OR CONTRACT
INDEBTEDNESS FOR DEDUCTION FROM ASSESSED
VALUATION State Form 43709 (1-90) Frescribed by the
State Board of Tax Commissioners
� Instructions for filing:
To be filed in person or by mail with the County Auditor of the courity where the
property is located during the 12 months before May 11 of the year the deduction
is to be effective. See reverse for additional insiructions and qualifications.
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Filin fee $1.00
County �un ipL Year
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GIBSON GJ�;I7`; r,UDiTOR ,
Appf nt (Owner or c ract buyer - see restr o on reverse) �
Taxing District Key NumbedLega D scription Record No. _ 00
O� - (�Q - Q� Page No.
Assessed value of real property as Mortgage/Contract Indebtedness unpaid Is the applicant the sole legal or
of March 1, current year as of arch 1, current year. equitable owner? � yes � no
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If no, what is his/her exact share or interest? . If owned with someone other.than spouse,
indicate with whom.
If name on record is different than that of applicant, indicate below:
Name of mortgagee or contract seller � �
�ddress of mortgagee or contract seller
Name of Assignee or other owner or holder of Mortgage. •
Address of Assignee �
Does applicant own real property If yes, what county? What Taxing District? Has this deduction been
in any other county in Indiana? requested on property for current
year? O yes O no
COUNTY BOARD OF REVIEW ACTION
Deduction approved in the amount of:
19 � 19a�1 -a 19 03 190 j�,oaf �.9�6�
- -61 - - a2. -�o ea ('�!fi C3 0 �%' �
Signature _ Secretary of Board of Review Date � bo 9- /°
O S o�.
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I/We certify under penalty oi perjury that the above and foregoing information is true and correct and that the appli;
^�nts was/were a resident of Indiana and owner of the aforementioned property on March 1, 19
�nature (own rs full name) Person authorized by duly executed Power of Attorney or
by IC 6-1.1-12-.07).
Full Resident Addr of Aplicant Address of Authorized Person